一期游离皮瓣联合二期同种异体肌腱移植修复重建手腕背部复合组织损伤  

Two-stage repair of composite soft tissue defect of dorsal wrist:Free flap transfer followed by transplantation of allogeneic tendon

作　　者：王祥[1] 李青松[1] 梁伟[1] 季亮[1] 胡兴峰[1] 张博伟 徐鼎 刘文科 WANG Xiang;LI Qingsong;LIANG Wei;JI Liang;HU Xingfeng;ZHANG Bowei;XU Ding;LIU Wenke(Department of Hand and Microsurgery,Guiyang Fourth People's Hospital,Guiyang 550002,China)

机构地区：[1]贵阳市第四人民医院手显微外科,贵阳550002

出　　处：《中华显微外科杂志》2022年第6期643-649,共7页Chinese Journal of Microsurgery

基　　金：贵州省临床重点专科建设项目(黔卫健函(2021)160号)。

摘　　要：目的探讨分期应用游离皮瓣联合同种异体肌腱移植修复重建手腕背部复合组织损伤的临床效果。方法自2018年11月至2021年1月,贵阳市第四人民医院手显微外科共收治6例手腕背部复合组织损伤并伸肌腱缺损患者,年龄22~62(平均45)岁。软组织缺损面积为5.0 cm×12.0 cm~8.0 cm×20.0 cm,均位于腕背部。合并指伸肌腱缺损2条2例、3条1例、4条2例、5条1例,缺损长度7.0~22.0 cm。5例急诊彻底清创后行VSD敷料覆盖创面5~7 d。创面清洁后一期进行游离ALTF覆盖3例,游离髂腹股沟皮瓣覆盖2例,院外转入植皮愈合瘢痕切除同时进行游离ALTF覆盖1例。术后3~4个月,采用同种异体肌腱移植进行伸指功能重建。术后门诊定期随访,观察皮瓣外形及手指功能。结果术后随访10~26个月,平均15个月。术后6例皮瓣完全成活,其中1例于二期术后4个月行皮瓣修薄术。皮瓣外形、色泽、质地良好,供区愈合良好,均无功能和感觉障碍。所有移植肌腱滑动良好,均无粘连。末次随访患者掌指关节主动活动度为(10±10)°~(80±10)°,远、近侧指骨间关节主动活动均正常,按中华医学会手外科学会上肢部分功能评定试用标准评定,结果优4例、良2例。结论一期利用游离ALTF或游离髂腹股沟皮瓣联合二期同种异体肌腱重建手腕背部复合组织损伤,可最大程度减轻肌腱移植术后粘连和供区损害,临床效果好,是一种安全、有效、可行的治疗方法。Objective To explore the clinical effect of a two-staged repair and reconstruction of composite soft tissue defect of dorsal wrist with transfer of free flap(in stage-one)repair and followed by transplantation of allogeneic tendon(in stage-two)reconstruction.Methods From December 2018 to January 2021,6 cases with dorsal wrist composite tissue injury and extensor tendon defect were treated in the Department of Hand and Microsurgery of the Fourth People's Hospital of Guiyang City.Four cases were treated with free anterolateral thigh flap(ALTF)combined with allogeneic tendon in the first stage to reconstruct finger dorsiflexion function,and 2 cases were treated with free ilioinguinal flap combined with allogeneic tendon in the second stage to reconstruct finger dorsiflexion function.The age of the patients ranged from 22 to 62 years old.The areas of defect were 5.0 cm×12.0 cm-8.0 cm×20.0 cm.Two cases had 2 extensor tendons defect,1 had 3 extensor tendons defect,2 had 4 extensor tendons defect,and 1 had 5 extensor tendons defect.The length of extensor tendon defects was 7.0-22.0 cm.In 5 cases,the wounds were covered by VSD for 5 to 7 days after complete emergenly debridement.Then,after the wounds had been cleared and clean,the wounds of 3 cases were covered with free ALTF,2 with free ilioinguinal flap,and 1 with free ALTF after skin graft scar resection.At 3-4 months later,the extension function of digit was reconstructed with the transplantation of allogeneic tendons.Postoperative appearance of the flaps and functions of digits were observed at the outpatient clinics during the follow-up.Results The postoperative follow-up lasted for 10 to 26(15 in average)months.All 6 flaps surrived completely,and 1 case was further treated with flap thinning at 4 months after the second surgery.During the follow-up,all flaps healed well and were good in appearance and texture.Meanwhile,the donor areas were all healed well with no dysfunction nor sensory disorder.All the transplanted tendons were in good glide without adhesion.Th

关 键 词：股前外侧皮瓣 髂腹股沟皮瓣 同种异体肌腱 腕关节 复合组织损伤 

分 类 号：R658.2[医药卫生—外科学]